On Demand: Coding and Reimbursement for OBLs and ASCs-Question and Answer

Question and Answer

Pdf Summary

The question and answer session focuses on coding and reimbursement for freestanding outpatient-based labs (OBLs) and ambulatory surgical centers (ASCs). <br /><br />Q1 addresses whether an OBL can be freestanding if billed under the group tax ID. The answer clarifies that OBLs are typically required to be under the same tax ID since they are considered an extension of the practice. <br /><br />Q2 inquires about the usage of C codes for devices performed in an ASC. The response states that the usage of C codes depends on the carrier. From a Medicare perspective, both the CPT code and the HCPCs code for device services should be reported. <br /><br />Q3 concerns the appropriate use of modifiers when a coronary angiography codes with intravascular ultrasound (IVUS) or fractional flow reserve (FFR) is performed as a distinct diagnostic study with an intervention. The answer mentions the lack of guidance with the new HCPC C codes and advises directly contacting carriers for guidance and policies. <br /><br />Q4 queries the reporting of codes when a coronary angiography in or through a bypass is done with both IVUS and FFR. The answer advises reaching out to the carrier for specific reporting instructions as reporting both codes may result in duplicating the reporting of the cardiac cath. <br /><br />Q5 asks whether the additional IVUS add-on code should still be reported with the new C codes for IVUS in additional vessels. The response suggests checking with the carrier directly for their preferred reporting approach given the limited guidance with the new C codes. <br /><br />Q6 inquires about device reimbursement in OBLs compared to ASCs. The answer directs individuals to refer to their respective carrier's fee schedule as reimbursement can vary.

Keywords

coding

reimbursement

OBLs

ASCs

group tax ID

C codes

device services

coronary angiography

IVUS

FFR